Doulas

The origin of the word Doula
The prestigious medical journal New England Medical Journal published a study in the 80s made by Dr. Klaus and Kenon in a large public hospital in Guatemala (60 births a day) during the 70's. They found that the rate of interventions, caesarean section and was very high drug spending. To try to solve the problem by performing the following study: randomly assigned women to other women who were mothers, with experience in birth, so that will handle labor and other health personnel were assigned, as usual. They found that younger women had far fewer interventions stated.
Repeating the study in Houston, Texas, with lower-class women, mostly Mexican and Puerto Rican migrants, and the results were very similar. Surprisingly, it turned to be done with middle-class American women, with different results.

When published these studies did not find the right word to describe the woman who accompanied the birth, and chose the Greek word "doula." It is a word that comes from ancient Greek and means slave or servant in a big house, and that probably helped the woman of the house during the birth process. But in reality, since this word literally means servant in Greek environments prefer to use the name "paramana doula" which has a meaning closer to that being sought. Anyway, throughout the world is identified with the name doula to women, with knowledge of labor and birth itself, which accompanies the woman who will give birth.

What is a doula?
A doula is an experienced birth assistance provides ongoing support, information and emotional and physical support to pregnant women before, during and just after childbirth. Doulas attend women giving birth in hospitals, homes and at home births.

The first mission of the doula is to report positively on the experience of motherhood and childbirth for pregnant women and their families. The foundation of a doula care is based on the knowledge that the continuous emotional support and confidence during the birthing process enhances and facilitates all stages of motherhood greatly.

The important thing about a doula is not, then what she knows, but who she is, his personality, because that is what most influences to help women in labor.


Tasks you can perform a doula:

* During pregnancy:
Discuss your goals for the birth and any doubt and fear
It complements the information received in the childbirth preparation classes by the midwife
It reports the birth process and the pain and suggested ideas to improve comfort appropriate to the circumstances
Provides advice on a birth plan to consult with your doctor or midwife
* During labor
Accompanies you when you feel the need for their support, offering emotional support
He is with you to answer your questions and encourage you
Suggests ways to endure the pain and facilitate delivery in collaboration with the medical staff
It acts as a watchdog of the wishes of the mother during the birth process against unwanted interventions
Help creating a suitable environment for the mother (reducing noise and light, playing music, adjusting the heat or cold, answering the phone, etc.).
Help in a VBAC (vaginal birth after cesarean), if applicable
Works with a midwife in the care of a home birth
Respect the privacy of the woman in labor
Provides support and security to other family members
* After the baby is born
Help through postpartum procedures
It facilitates the early establishment of breastfeeding
Maintains telephone contact for any query
Help in the care of the house and the other brothers to reassure the new mother and free of charge

But really, what changes with a doula?
According to the book "mothering the mother, how a doula can help you have a shorter birth, easy and healthy" by Kennel, Klaus and Kennel (Mothering the Mother, How a Doula Can Help You Have a Shorter, Easier and Healthier Birth (1993)) a doula can provide the following differences:

* 50% reduction in caesarean sections
* 25% shorter labor
* 60% fewer requests for epidural
* 40% less use of synthetic oxytocin
* 30% less analgesic use
* 40% less use of forceps
* Improves parent-infant bond
* Less problems with breastfeeding
* Reduced incidence of postpartum depression

A study by Case Western Reserve University in Cleveland, USA, showed that while 63% of women who did not have the support of a doula needed a cesarean delivery after induction, only 20% of those who were in a doula with them the required.

Doulas, midwives and doctors
The midwife and the doctor can provide all the necessary care for a woman and her baby throughout pregnancy, birth and after it. They have all the knowledge and equipment necessary to advise of any deviation from normal and act accordingly. The role of the midwife is physical and emotional support during the birth experience by using their knowledge and skills in education, counseling and health promotion.

The doula provides emotional care and practical assistance to women and their families before, during and after delivery. It can provide information, advice and support, but is not qualified to engage in any clinical task. However, you can be knowledgeable about massage, reflexology, homeopathy and breastfeeding. Is the person chosen by women and / or partner to protect them in their birth experience and assist in their transition to motherhood and fatherhood. His work comes from the work traditionally done by other women of the family or neighborhood (as in many cultures yet). The doula is also the person who protects women to respect their wishes, facilitating communication between it and the midwives and doctors.

One aspect that differentiates the role of the doula is your ongoing care. As labor begins, she is with the woman until the end. All requirements have been established and has agreed beforehand how the doula can help women in childbirth and after him, with the new baby. There are no shift changes or other obligations. Not so in the case of the midwife, who often do not have time to listen, educate and guide women in their entry into motherhood. Instead, the doula can spend several hours a day helping with breastfeeding, preparing meals or taking older siblings. The doula can negotiate with the mother some flexibility to allow you to meet the needs of his own family, something that some midwives also would like.

According to the spokesperson of the American Academy of Obstetrics and Gynecology, the doula provides support to people in the delivery room "if they know what their role in the birth process ... and that its most important function is to support psychological mother. " But sometimes, due to lack of time and dedication of doctors and midwives, parents tend to ask more to the person you have had more relationship and contact, the doula, whose expertise may not be as comprehensive and accurate like a doctor or midwife, who have had several years of college.

Dr. Marshall Klaus, a professor of pediatrics at the University of California at San Francisco, is a pioneering researcher on the benefits of the presence of doulas, published in the Journal of the American Medical Association in 1991. It was he who helped found the association of Doulas of North America. The courses for doulas, the group strongly advised not face any medical decision. "Sometimes, even though they often say that doulas should be discussed with a doctor, they do," says Dr. Klaus.

The trouble is when doctors or midwives decide to do something, like a shaving, enema and episiotomy, the evidence-based investigations have proved unnecessary. Often hospital practices are more of a protocol established by a decision taken by the particular situation. The doula should be able to distinguish such situations from those where there is a real risk, without dealing with the medical staff, informing and giving constant support to the mother.


Are doulas the guardians of normal birth mass in front of the medicalization?
Traditionally, midwives were the guardians of normal childbirth, but if they can not, any alternative must be found. Even some midwives do not want to provide women the kind of support they need to have the greatest opportunities for a normal delivery. Women who are confident in preserving a normal delivery are beginning to increase the volume of their demands. This claim also includes some midwives do not conform to the current situation, pregnant women and doulas. Some doulas are old midwives or mothers who feel the need to do something to defend the normal physiology of pregnancy, childbirth and baby's first days, before the excessive medicalization and current intervention.

Do you feel the father moved to the presence of a doula?
Not at all. Normally, prospective parents receive this woman experienced with open arms. The doula does not displace the couple at birth, rather takes the pressure of having to take care of it (and its environment, or other children, home, extended family, etc.) So that he can do it does best: love.